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Palomaki GE, Wyatt P, Rowsey R, Cacheris PM, Lepage N, Natowicz MR, Long T, Moyer AM. Numbers of prenatal cell-free DNA screens performed: Results of a 2022 CAP exercise. Prenat Diagn 2024. [PMID: 38622635 DOI: 10.1002/pd.6574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/06/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Determine current analytical methods and number of cell-free (cf) DNA prenatal screening tests performed for common trisomies. METHODS The College of American Pathologists 2022-B Noninvasive Prenatal Testing exercise was distributed in December 2022 to 93 participants in 22 countries. Supplemental questions included the number of tests performed in a recent month and the proportion of samples originating outside the United States (US). RESULTS Eighty-three participants from three continents returned results; 74 (89%) were suitable for the analyses. Nine manufacturer/platform combinations were identified, most commonly Illumina/Nextseq (55%). The most common methodology was whole genome sequencing (76%). Annualized cfDNA tests were 2.80 million, with Asian, European and North American participants representing 10.6%, 6.5% and 82.9% of tests, respectively. When restricted to US in-country tests, the annualized rate was 2.18 million, with four of 20 participants testing 79.2%. Among 73 respondents, 63 (86%) were for-profit, eight (11%) were non-profit academic or government supported and the remaining two included hospital-based and private non-profit. Eighteen (25%) supported relevant academic training. CONCLUSION In 2011, screening for common trisomies was based on serum/ultrasound markers with an estimated 2.96 million US pregnancies screened in 131 laboratories. In 2022, cfDNA-based screening was offered by 20 laboratories testing 2.18 million US pregnancies.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University, Women & Infants Hospital of RI, Providence, Rhode Island, USA
| | - Philip Wyatt
- Esoterix Genetic Laboratories, Santa Fe, New Mexico, USA
| | - Ross Rowsey
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nathalie Lepage
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Marvin R Natowicz
- Pathology and Laboratory Medicine, Genomic Medicine, Neurology and Pediatrics Institutes, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas Long
- Department of Biostatistics, College of American Pathologists, Northfield, Illinois, USA
| | - Ann M Moyer
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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2
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Osinga JAJ, Liu Y, Männistö T, Vafeiadi M, Tao FB, Vaidya B, Vrijkotte TGM, Mosso L, Bassols J, López-Bermejo A, Boucai L, Aminorroaya A, Feldt-Rasmussen U, Hisada A, Yoshinaga J, Broeren MAC, Itoh S, Kishi R, Ashoor G, Chen L, Veltri F, Lu X, Taylor PN, Brown SJ, Chatzi L, Popova PV, Grineva EN, Ghafoor F, Pirzada A, Kianpour M, Oken E, Suvanto E, Hattersley A, Rebagliato M, Riaño-Galán I, Irizar A, Vrijheid M, Delgado-Saborit JM, Fernández-Somoano A, Santa-Marina L, Boelaert K, Brenta G, Dhillon-Smith R, Dosiou C, Eaton JL, Guan H, Lee SY, Maraka S, Morris-Wiseman LF, Nguyen CT, Shan Z, Guxens M, Pop VJM, Walsh JP, Nicolaides KH, D'Alton ME, Visser WE, Carty DM, Delles C, Nelson SM, Alexander EK, Chaker L, Palomaki GE, Peeters RP, Bliddal S, Huang K, Poppe KG, Pearce EN, Derakhshan A, Korevaar TIM. Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis. Thyroid 2024. [PMID: 38546971 DOI: 10.1089/thy.2023.0646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p < 0.001), subclinical hypothyroidism (risk for antibody negativity 2.2%, isolated TgAb positivity 8.1%, isolated TPOAb positivity 14.2%, combined antibody positivity 20.0%; p < 0.001) and a treatment indication (risk for antibody negativity 0.2%, isolated TgAb positivity 2.2%, isolated TPOAb positivity 3.0%, and combined antibody positivity 5.1%; p < 0.001). Twin pregnancy was associated with a higher risk of overt hyperthyroidism (5.6% vs. 0.7%; p < 0.001). Conclusions: The risk factors assessed in this study had poor predictive ability for detecting thyroid function test abnormalities, questioning their clinical usability for targeted screening. As expected, TPOAb positivity (used as a benchmark) was a relevant risk factor for (subclinical) hypothyroidism. These results provide insights into different risk factors for gestational thyroid dysfunction.
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Affiliation(s)
- Joris A J Osinga
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yindi Liu
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tuija Männistö
- Northern Finland Laboratory Center Nordlab and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, United Kingdom
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Lorena Mosso
- Departments of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
- Departament de Ciències Mèdiques, Universitat de Girona, Girona, Spain
| | - Laura Boucai
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, New York, USA
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Aya Hisada
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Jun Yoshinaga
- Faculty of Life Sciences, Toyo University, Gunma, Japan
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ghalia Ashoor
- Harris Birthright Research Center for Fetal Medicine, King's College Hospital, London, United Kingdom
| | - Liangmiao Chen
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Flora Veltri
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Xuemian Lu
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Polina V Popova
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Elena N Grineva
- Department of Endocrinology, First Medical University, Saint Petersburg, Russia
| | - Farkhanda Ghafoor
- Department of Research and Innovation, Shalamar Institute of Health Sciences, Lahore, Pakistan
| | | | - Maryam Kianpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Andrew Hattersley
- Department of Molecular Medicine, University of Exeter Medical School, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom
| | - Marisa Rebagliato
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Predepartamental Unit of Medicine, Jaume I University, Castelló, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Isolina Riaño-Galán
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
- IUOPA-Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
- Servicio de Pediatría, Endocrinología Pediátrica, HUCA, Oviedo, Asturias, Spain
| | - Amaia Irizar
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian, Spain
- Department of Preventive Medicine and Public Health, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Martine Vrijheid
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Juana Maria Delgado-Saborit
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Department of Medicine, Faculty of Health Sciences, Universitat Jaume I, Castellón de la Plana, Spain
| | - Ana Fernández-Somoano
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
- IUOPA-Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
| | - Loreto Santa-Marina
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian, Spain
- Department of Health of the Basque Government, Subdirectorate of Public Health of Gipuzkoa, San Sebastian, Spain
| | - Kristien Boelaert
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Gabriela Brenta
- Department of Internal Medicine, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - Rima Dhillon-Smith
- Tommys National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Chrysoula Dosiou
- Division of Endocrinology, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer L Eaton
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, and Women and Infants Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Haixia Guan
- The First Hospital of China Medical University, Shenyang, China
| | - Sun Y Lee
- Section of Endocrinology, Diabetes, and Nutrition, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Endocrine Section, Medicine Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Lilah F Morris-Wiseman
- Division of Endocrine Surgery, Johns Hopkins Department of Surgery, Baltimore, Maryland, USA
| | - Caroline T Nguyen
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Mònica Guxens
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Kypros H Nicolaides
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine King's College London, London, United Kingdom
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - W Edward Visser
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - David M Carty
- Department of Diabetes, Endocrinology and Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Scott M Nelson
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Erik K Alexander
- Division of Endocrinology, Hypertension and Diabetes, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, Scientific Research Center in Preventive Medicine; School of Public Health; Anhui Medical University, Hefei, Anhui, China
| | - Kris G Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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3
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Osinga JAJ, Derakhshan A, Feldt-Rasmussen U, Huang K, Vrijkotte TGM, Männistö T, Bassols J, López-Bermejo A, Aminorroaya A, Vafeiadi M, Broeren MAC, Palomaki GE, Ashoor G, Chen L, Lu X, Taylor PN, Tao FB, Brown SJ, Sitoris G, Chatzi L, Vaidya B, Popova PV, Vasukova EA, Kianpour M, Suvanto E, Grineva EN, Hattersley A, Pop VJM, Nelson SM, Walsh JP, Nicolaides KH, D’Alton ME, Poppe KG, Chaker L, Bliddal S, Korevaar TIM. TSH and FT4 Reference Interval Recommendations and Prevalence of Gestational Thyroid Dysfunction: Quantification of Current Diagnostic Approaches. J Clin Endocrinol Metab 2024; 109:868-878. [PMID: 37740543 PMCID: PMC10876390 DOI: 10.1210/clinem/dgad564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/14/2023] [Accepted: 09/21/2023] [Indexed: 09/24/2023]
Abstract
CONTEXT Guidelines recommend use of population- and trimester-specific thyroid-stimulating hormone (TSH) and free thyroxine (FT4) reference intervals (RIs) in pregnancy. Since these are often unavailable, clinicians frequently rely on alternative diagnostic strategies. We sought to quantify the diagnostic consequences of current recommendations. METHODS We included cohorts participating in the Consortium on Thyroid and Pregnancy. Different approaches were used to define RIs: a TSH fixed upper limit of 4.0 mU/L (fixed limit approach), a fixed subtraction from the upper limit for TSH of 0.5 mU/L (subtraction approach) and using nonpregnancy RIs. Outcome measures were sensitivity and false discovery rate (FDR) of women for whom levothyroxine treatment was indicated and those for whom treatment would be considered according to international guidelines. RESULTS The study population comprised 52 496 participants from 18 cohorts. Compared with the use of trimester-specific RIs, alternative approaches had a low sensitivity (0.63-0.82) and high FDR (0.11-0.35) to detect women with a treatment indication or consideration. Sensitivity and FDR to detect a treatment indication in the first trimester were similar between the fixed limit, subtraction, and nonpregnancy approach (0.77-0.11 vs 0.74-0.16 vs 0.60-0.11). The diagnostic performance to detect overt hypothyroidism, isolated hypothyroxinemia, and (sub)clinical hyperthyroidism mainly varied between FT4 RI approaches, while the diagnostic performance to detect subclinical hypothyroidism varied between the applied TSH RI approaches. CONCLUSION Alternative approaches to define RIs for TSH and FT4 in pregnancy result in considerable overdiagnosis and underdiagnosis compared with population- and trimester-specific RIs. Additional strategies need to be explored to optimize identification of thyroid dysfunction during pregnancy.
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Affiliation(s)
- Joris A J Osinga
- Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and clinical Sciences, Copenhagen University, 1172 Copenhagen, Denmark
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, 230032 Anhui, China
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Tuija Männistö
- Northern Finland Laboratory Center Nordlab and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90570 Oulu, Finland
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, 17007 Girona, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, 17007 Girona, Spain
- Departament de Ciències Mèdiques, Universitat de Girona, 17003 Girona, Spain
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, 81745-33871 Isfahan, Iran
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, 710 03 Crete, Greece
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Hematology, Máxima Medical Centre, 5504 DB Veldhoven, The Netherlands
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, Providence, RI 02903, USA
| | - Ghalia Ashoor
- Harris Birthright Research Center for Fetal Medicine, King’s College Hospital, SE5 9RS London, UK
| | - Liangmiao Chen
- Department of Endocrinology and Rui’an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, 325035 Wenzhou, China
| | - Xuemian Lu
- Department of Endocrinology and Rui’an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, 325035 Wenzhou, China
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, CF10 3EU Cardiff, UK
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 230032 Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, 230032 Anhui, China
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, 6009 Nedlands, Perth, Australia
| | - Georgiana Sitoris
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Lida Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, EX1 2LU Exeter, UK
| | - Polina V Popova
- Institute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia
- World-Class Research Center for Personalized Medicine, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia
| | - Elena A Vasukova
- Institute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia
| | - Maryam Kianpour
- Departament de Ciències Mèdiques, Universitat de Girona, 17003 Girona, Spain
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, 90570 Oulu, Finland
| | - Elena N Grineva
- Institute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia
| | - Andrew Hattersley
- Molecular Medicine, University of Exeter Medical School, Royal Devon & Exeter Hospital, EX3 0AW Exeter, UK
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Scott M Nelson
- School of Medicine, University of Glasgow, G12 8QQ Glasgow, UK
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, 6009 Nedlands, Perth, Australia
- Medical School, University of Western Australia, Crawley, WA 6009, Australia
| | - Kypros H Nicolaides
- Department of Women and Children’s Health, Faculty of Life Sciences and Medicine King’s College London, SE5 9RS London, UK
| | - Mary E D’Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, NewYork, NY 10032, USA
| | - Kris G Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
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4
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Palomaki GE, Lambert-Messerlian GM, Fullerton D, Hegde M, Conotte S, Saidel ML, Jani JC. Cell-free DNA-based prenatal screening via rolling circle amplification: Identifying and resolving analytic issues. J Med Screen 2023; 30:168-174. [PMID: 37194254 PMCID: PMC10629251 DOI: 10.1177/09691413231173315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE A rolling circle amplification (RCA) based commercial methodology using cell-free (cf)DNA to screen for common trisomies became available in 2018. Relevant publications documented high detection but with a higher than expected 1% false positive rate. Preliminary evidence suggested assay variability was an issue. A multi-center collaboration was created to explore this further and examine whether subsequent manufacturer changes were effective. METHODS Three academic (four devices) and two commercial (two devices) laboratories provided run date, chromosome 21, 18, and 13 run-specific standard deviations, number of samples run, and reagent lot identifications. Temporal trends and between-site/device consistency were explored. Proportions of run standard deviations exceeding pre-specified caps of 0.4%, 0.4% and 0.6% were computed. RESULTS Overall, 661 RCA runs between April 2019 and July 30, 2022 tested 39,756 samples. In the first 24, subsequent 9, and final 7 months, proportions of capped chromosome 21 runs dropped from 39% to 22% to 6.0%; for chromosome 18, rates were 76%, 36%, and 4.0%. Few chromosome 13 runs were capped using the original 0.60%, but capping at 0.50%, rates were 28%, 16%, and 7.6%. Final rates occurred after reformulated reagents and imaging software modifications were fully implemented across all devices. Revised detection and false positive rates are estimated at 98.4% and 0.3%, respectively. After repeat testing, failure rates may be as low as 0.3%. CONCLUSION Current RCA-based screening performance estimates are equivalent to those reported for other methods, but with a lower test failure rate after repeat testing.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, Providence, RI, USA
| | - Geralyn M Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, Providence, RI, USA
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI, USA
| | - Donna Fullerton
- Department of Clinical Chemistry, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Madhuri Hegde
- Global Laboratory Services, PerkinElmer, Inc, Atlanta, GA, USA
| | - Stéphanie Conotte
- Department of Blood Transfusion, University Hospital Brugmann, Brussels, Belgium
| | | | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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5
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Osinga JAJ, Derakhshan A, Palomaki GE, Ashoor G, Männistö T, Maraka S, Chen L, Bliddal S, Lu X, Taylor PN, Vrijkotte TGM, Tao FB, Brown SJ, Ghafoor F, Poppe K, Veltri F, Chatzi L, Vaidya B, Broeren MAC, Shields BM, Itoh S, Mosso L, Popova PV, Anopova AD, Kishi R, Aminorroaya A, Kianpour M, López-Bermejo A, Oken E, Pirzada A, Vafeiadi M, Bramer WM, Suvanto E, Yoshinaga J, Huang K, Bassols J, Boucai L, Feldt-Rasmussen U, Grineva EN, Pearce EN, Alexander EK, Pop VJM, Nelson SM, Walsh JP, Peeters RP, Chaker L, Nicolaides KH, D’Alton ME, Korevaar TIM. TSH and FT4 Reference Intervals in Pregnancy: A Systematic Review and Individual Participant Data Meta-Analysis. J Clin Endocrinol Metab 2022; 107:2925-2933. [PMID: 35861700 PMCID: PMC9516198 DOI: 10.1210/clinem/dgac425] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 12/02/2022]
Abstract
CONTEXT Interpretation of thyroid function tests during pregnancy is limited by the generalizability of reference intervals between cohorts due to inconsistent methodology. OBJECTIVE (1) To provide an overview of published reference intervals for thyrotropin (TSH) and free thyroxine (FT4) in pregnancy, (2) to assess the consequences of common methodological between-study differences by combining raw data from different cohorts. METHODS (1) Ovid MEDLINE, EMBASE, and Web of Science were searched until December 12, 2021. Studies were assessed in duplicate. (2) The individual participant data (IPD) meta-analysis was performed in participating cohorts in the Consortium on Thyroid and Pregnancy. RESULTS (1) Large between-study methodological differences were identified, 11 of 102 included studies were in accordance with current guidelines; (2) 22 cohorts involving 63 198 participants were included in the meta-analysis. Not excluding thyroid peroxidase antibody-positive participants led to a rise in the upper limits of TSH in all cohorts, especially in the first (mean +17.4%; range +1.6 to +30.3%) and second trimester (mean +9.8%; range +0.6 to +32.3%). The use of the 95th percentile led to considerable changes in upper limits, varying from -10.8% to -21.8% for TSH and -1.2% to -13.2% for FT4. All other additional exclusion criteria changed reference interval cut-offs by a maximum of 3.5%. Applying these findings to the 102 studies included in the systematic review, 48 studies could be used in a clinical setting. CONCLUSION We provide an overview of clinically relevant reference intervals for TSH and FT4 in pregnancy. The results of the meta-analysis indicate that future studies can adopt a simplified study setup without additional exclusion criteria.
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Affiliation(s)
- Joris A J Osinga
- Correspondence: Joris Osinga, MD, Erasmus MC, Generation R, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, Providence, RI 02905, USA
| | - Ghalia Ashoor
- Harris Birthright Research Center for Fetal Medicine, King’s College Hospital, London, UK
| | - Tuija Männistö
- Northern Finland Laboratory Center Nordlab and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
- Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Liangmiao Chen
- Department of Endocrinology and Rui’an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Xuemian Lu
- Department of Endocrinology and Rui’an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, China
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Farkhanda Ghafoor
- Department of Research and Innovation, Shalamar Institute of Health Sciences, Lahore, Pakistan
| | - Kris Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Flora Veltri
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lida Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, CA 90089, USA
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, UK
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Beverley M Shields
- Department of Medical Statistics, University of Exeter Medical School, Exeter, UK
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Lorena Mosso
- Departments of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Polina V Popova
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St. Petersburg Pavlov State Medical University, Saint Petersburg, Russian Federation
- World-Class Research Center for Personalized Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Anna D Anopova
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Kianpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
- Departament de Ciències Mèdiques, Universitat de Girona, Spain
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Amna Pirzada
- Shifa Institute of Medical Technology, Shifa International Hospital, Islamabad, Pakistan
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Wichor M Bramer
- Medical Library, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Jun Yoshinaga
- Faculty of Life Sciences, Toyo University, Gunma, Japan
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, Scientific Research Center in Preventive Medicine; School of Public Health; Anhui Medical University, China
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
| | - Laura Boucai
- Department of Medicine, Division of Endocrinology, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, NY 10065, USA
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Elena N Grineva
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts 02118, USA
| | - Erik K Alexander
- Division of Endocrinology, Hypertension and Diabetes, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 0211, USA
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | | | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kypros H Nicolaides
- Department of Women and Children’s Health, Faculty of Life Sciences and Medicine King’s College London, London, UK
| | - Mary E D’Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York 10032, USA
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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Palomaki GE, Eklund EE, Kloza EM, Lambert-Messerlian GM. Assessment of a Simplified Cell-Free DNA Method for Prenatal Down Syndrome Screening. Clin Chem 2022; 68:1449-1458. [DOI: 10.1093/clinchem/hvac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Prenatal screening for common trisomies via cell-free (cfDNA) is usually implemented by technologies utilizing massively parallel sequencing, stringent environmental controls, complex bioinformatics, and molecular expertise. An alternative and less complex methodology utilizes rolling circle amplification (RCA). Further evaluation of its performance and related requirements are warranted.
Methods
At 16 sites, women at 10 to 20 weeks gestation provided informed consent, relevant information, and 2 to 3 blood samples. Samples shipped for testing were processed and stored. Women were enrolled at primary cfDNA screening, or following such screening at referral for diagnostic testing. RCA testing occurred post-enrollment, over 11 months. Diagnostic results and delivery notes determined clinical truth. Detection rates were based on confirmed trisomic pregnancies; false-positive rates were based on unaffected pregnancies from the general population.
Results
Detection rate for the common trisomies was 95.9% (117/122, 95% CI, 90.5%–98.5%); overall false-positive rate was 1.00% (22/2,205, 0.65%–1.51%). Test failure rate after repeat testing was 0.04%. When assay standard deviations were below pre-specified levels, the overall false-positive rate was much lower at 0.30% (P < 0.001). Fetal sex calls were correct for 99.7%. One technician analyzed 560 samples over 2 weeks, a rate of 14 000/year.
Conclusions
Our assessment of this simplified cfDNA-based system for prenatal screening for common trisomies performed in a prenatal screening laboratory is encouraging. Improved detection, low failure rates and rapid reporting can be achieved by collecting 2 samples. Future priorities should include achieving higher run precision using a single collection tube.
Clinicaltrials.gov Registration Number: NCT03087357.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital , Providence, RI , USA
- Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University , Providence, RI , USA
| | - Elizabeth E Eklund
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital , Providence, RI , USA
| | - Edward M Kloza
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital , Providence, RI , USA
| | - Geralyn M Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital , Providence, RI , USA
- Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University , Providence, RI , USA
- Department of Obstetrics and Gynecology, Women & Infants Hospital , Providence, RI , USA
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7
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Hardy EJ, Palomaki GE, Sung CJ, Lambert-Messerlian GM. Surveillance of SARS-CoV-2 Antibodies in Early 2020 among Rhode Island Pregnancies. Ann Clin Lab Sci 2022; 52:788-795. [PMID: 36261192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Limited data are available on the performance of SARS-CoV-2 antibody assays and data collected during pregnancy vary widely. The objective of this study was to estimate the seroprevalence of antibodies against SARS-CoV-2 in pregnant individuals in Rhode Island and to evaluate whether the prevalence differed by month of collection, age, county of residence, or economic status as estimated by zip code. METHODS Pre-pandemic (2019) and early pandemic (2020) serum samples, collected for prenatal screening between 15 and 22 weeks of gestation, were analyzed utilizing two SARS-CoV-2 immunoglobulin G (IgG) automated assays that targeted the viral nucleocapsid (anti-N) or spike (anti-S) receptor binding domain proteins. RESULTS Among 756 pre-pandemic samples, one anti-S IgG and 13 anti-N IgG were identified. No samples were positive for both. Among 787 pandemic specimens, 16 (2.03%) were positive for both anti-N IgG and anti-S IgG. When stratified by month of collection, there was a significant increase in seropositivity rate (p=0.023). Seropositivity rates were associated with lower income levels (p=0.08) but this was not statistically significant. No trend by maternal age was found (p=0.70). CONCLUSIONS When a positive result was defined as both anti-N IgG and anti-S IgG, false positives were unlikely. Based on this methodology, serology could be utilized to monitor infection trends during pregnancy.
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Affiliation(s)
- Erica J Hardy
- Department of Medicine, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School at Brown University, Providence, RI, USA
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - C James Sung
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Geralyn M Lambert-Messerlian
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School at Brown University, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School at Brown University, Providence, RI, USA
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8
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Lyon E, Temple-Smolkin RL, Hegde M, Gastier-Foster JM, Palomaki GE, Richards CS. An Educational Assessment of Evidence Used for Variant Classification: A Report of the Association for Molecular Pathology. J Mol Diagn 2022; 24:555-565. [PMID: 35429647 DOI: 10.1016/j.jmoldx.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/12/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
The Association for Molecular Pathology Variant Interpretation Testing Among Laboratories (VITAL) Working Group convened to evaluate the Standards and Guidelines for the Interpretation of Sequence Variants implementation into clinical practice, identify problematic classification rules, and define implementation challenges. Variants and associated clinical information were provided to volunteer respondents. Participant variant classifications were compared with intended consensus-derived classifications of the Working Group. The 24 variant challenges received 1379 responses; 1119 agreed with the intended response (81%; 95% CI, 79% to 83%). Agreement ranged from 44% to 100%, with 16 challenges (67%; 47% to 82%) reaching consensus (≥80% agreement). Participant classifications were also compared to a calculated interpretation of the ACMG Guidelines using the participant-reported criteria as input. The 24 variant challenges had 1368 responses with specific evidence provided and 1121 (82%; 80% to 84%) agreed with the calculated interpretation. Agreement for challenges ranged from 63% to 98%; 15 (63%; 43% to 79%) reaching consensus. Among 81 individual participants, 32 (40%; 30% to 50%) reached agreement with at least 80% of the intended classifications and 42 (52%; 41% to 62%) with the calculated classifications. This study demonstrated that although variant classification remains challenging, published guidelines are being utilized and adapted to improve variant calling consensus. This study identified situations where clarifications are warranted and provides a model for competency assessment.
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Affiliation(s)
- Elaine Lyon
- The Variant Interpretation Testing Among Laboratories (VITAL) Working Group of the Clinical Practice Committee, Association for Molecular Pathology (AMP), Rockville, Maryland; HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | | | - Madhuri Hegde
- The Variant Interpretation Testing Among Laboratories (VITAL) Working Group of the Clinical Practice Committee, Association for Molecular Pathology (AMP), Rockville, Maryland; Global Genetics Laboratory, PerkinElmer Genomics, Pittsburgh, Pennsylvania
| | - Julie M Gastier-Foster
- The Variant Interpretation Testing Among Laboratories (VITAL) Working Group of the Clinical Practice Committee, Association for Molecular Pathology (AMP), Rockville, Maryland; Departments of Pediatrics and Pathology/Immunology, Baylor College of Medicine, Houston, Texas; Pathology Department, Texas Children's Hospital, Houston, Texas; Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Glenn E Palomaki
- The Variant Interpretation Testing Among Laboratories (VITAL) Working Group of the Clinical Practice Committee, Association for Molecular Pathology (AMP), Rockville, Maryland; Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, Rhode Island
| | - C Sue Richards
- The Variant Interpretation Testing Among Laboratories (VITAL) Working Group of the Clinical Practice Committee, Association for Molecular Pathology (AMP), Rockville, Maryland; Department of Molecular and Medical Genetics and Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, Oregon.
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9
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Whelan AR, Lambert-Messerlian GM, Kloza EM, Palomaki GE. First-trimester screening for pre-eclampsia: estimated vs measured mean arterial pressure. Ultrasound Obstet Gynecol 2022; 59:692-693. [PMID: 34985821 DOI: 10.1002/uog.24850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Affiliation(s)
- A R Whelan
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI, USA
| | - G M Lambert-Messerlian
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - E M Kloza
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Providence, RI, USA
| | - G E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, RI, USA
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10
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Seifer DB, Lambert-Messerlian G, Palomaki GE, Silver RM, Parker C, Rowland Hogue CJ, Stoll BJ, Saade GR, Goldenberg RL, Dudley DJ, Bukowski R, Pinar H, Reddy UM. Preeclampsia at delivery is associated with lower serum vitamin D and higher antiangiogenic factors: a case control study. Reprod Biol Endocrinol 2022; 20:8. [PMID: 34991614 PMCID: PMC8734360 DOI: 10.1186/s12958-021-00885-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Preeclampsia is characterized by decreased trophoblastic angiogenesis leading to abnormal invasion of spiral arteries, shallow implantation and resulting in compromised placentation with poor uteroplacental perfusion. Vitamin D plays an important role in pregnancy influencing implantation, angiogenesis and placental development. The objective of this study was to determine whether there is an association between serum vitamin D levels, and anti-angiogenic factors at the time of delivery and the occurrence of preeclampsia. METHODS This nested case control study analyzed frozen serum samples at the time of delivery and related clinical data from women with singleton liveborn pregnancies who had participated in studies of the NICHD Stillbirth Collaborative Research Network. Women with a recorded finding of preeclampsia and who had received magnesium sulfate treatment prior to delivery were considered index cases (N = 56). Women without a finding of preeclampsia were controls (N = 341). RESULTS Women with preeclampsia had 14.5% lower serum vitamin D levels than women in the control group (16.5 ng/ml vs. 19 ng/ml, p = 0.014) with 64.5% higher sFlt-1 levels (11,600 pg/ml vs. 7050 pg/ml, p < 0.001) and greater than 2 times higher endoglin levels (18.6 ng/ml vs. 8.7 ng/ml, < 0.001). After controlling for gestational age at delivery and maternal BMI, vitamin D levels were 0.88 times lower (P = 0.051), while endoglin levels were 2.5 times higher and sFlt-1 levels were 2.1 times higher than in control pregnancies (P < 0.001). CONCLUSIONS Women with preeclampsia at time of delivery have higher maternal antiangiogenetic factors and may have lower maternal serum vitamin D levels. These findings may lead to a better understanding of the underlying etiology of preeclampsia as well as possible modifiable treatment options which could include assuring adequate levels of maternal serum vitamin D prior to pregnancy.
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Affiliation(s)
- David B. Seifer
- grid.47100.320000000419368710Department of Obstetrics and Gynecology, Yale University, New Haven, CT USA
| | - Geralyn Lambert-Messerlian
- grid.40263.330000 0004 1936 9094Department of Pathology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI USA
| | - Glenn E. Palomaki
- grid.40263.330000 0004 1936 9094Department of Pathology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI USA
| | - Robert M. Silver
- grid.223827.e0000 0001 2193 0096Department of Obstetrics and Gynecology, University of Utah Health Sciences, Salt Lake City, UT USA
| | - Corette Parker
- grid.62562.350000000100301493RTI International, Research Triangle Park, NC USA
| | - Carol J. Rowland Hogue
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Barbara J. Stoll
- grid.267308.80000 0000 9206 2401Department of Pediatrics, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX USA
| | - George R. Saade
- grid.176731.50000 0001 1547 9964Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX USA
| | - Robert L. Goldenberg
- grid.21729.3f0000000419368729Department of Obstetrics and Gynecology, Columbia University, New York, NY USA
| | - Donald J. Dudley
- grid.27755.320000 0000 9136 933XDepartment of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia USA
| | - Radek Bukowski
- grid.89336.370000 0004 1936 9924Department of Women’s Health, Dell Medical School, University of Texas at Austin, Austin, USA
| | - Halit Pinar
- grid.40263.330000 0004 1936 9094Department of Pathology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI USA
| | - Uma M. Reddy
- grid.47100.320000000419368710Department of Obstetrics and Gynecology, Yale University, New Haven, CT USA
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11
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Lepage N, Wyatt P, Ashwood ER, Best RG, Long T, Palomaki GE. Prenatal serum screening for Down syndrome and neural tube defects in the United States: Changes in utilization patterns from 2012 to 2020. J Med Screen 2021; 28:405-410. [PMID: 34279151 DOI: 10.1177/09691413211031610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compile current usage of serum-based prenatal screening for Down syndrome in the United States and compare it with results from a similar 2011/2012 survey. SETTING The College of American Pathologists maternal screening proficiency testing survey includes a supplemental question on the first of three yearly distributions. METHODS Information regarding tests offered and the monthly number of pregnancies tested for US-based laboratories were reviewed. Results were stratified by size of laboratory, tests offered, and pregnancies tested. Findings were compared to an earlier survey. RESULTS Fifty-six laboratories reported they will have screened 1,131,336 pregnancies in 2020. Of these, 36% are screened by stand-alone first trimester testing, 48% by stand-alone second trimester testing, and 16% using tests that integrate results from both trimesters. Eighty percent of all serum screens were provided by the five laboratories that performed the most screens (at least 50,000). These five performed similar proportions of first or second trimester screens (42.2% and 41.8%, respectively). Compared to eight years earlier, there are now 54% fewer laboratories. Pregnancies screened using the first trimester, second trimester, and integrated protocols were lower by 27%, 69%, and 72%, respectively. The serum screening activity in the US showed a 62% decrease from 2012 levels. During 2012-2020, the number of cell-free DNA tests increased from negligible to 1,492,332. CONCLUSIONS Maternal serum screening for common aneuploidies has changed significantly in eight years with fewer laboratories, a shift toward larger laboratories and a 2.5-fold reduction in pregnancies tested, likely due to the introduction of cell-free DNA screening.
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Affiliation(s)
- Nathalie Lepage
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Philip Wyatt
- Women's Health and Genetics, 364534LabCorp, LabCorp, Santa Fe, NM, USA
| | - Edward R Ashwood
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert G Best
- Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Thomas Long
- Department of Biostatistics, College of American Pathologists, Northfield, IL, USA
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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12
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Bean LJH, Scheuner MT, Murray MF, Biesecker LG, Green RC, Monaghan KG, Palomaki GE, Sharp RR, Trotter TL, Watson MS, Powell CM. DNA-based screening and personal health: a points to consider statement for individuals and health-care providers from the American College of Medical Genetics and Genomics (ACMG). Genet Med 2021; 23:979-988. [PMID: 33790423 DOI: 10.1038/s41436-020-01083-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Lora J H Bean
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - Maren T Scheuner
- Division of Medical Genetics, Department of Pediatrics, and Division of Hematology-Oncology, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA.,Clinical Genetics Program, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Michael F Murray
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert C Green
- Harvard Medical School, Boston, MA, USA.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, RI, USA.,Women and Infants Hospital, Providence, RI, USA
| | | | - Tracy L Trotter
- San Ramon Valley Primary Care Medical Group, San Ramon, CA, USA
| | | | - Cynthia M Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Genetics and Metabolism, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Palomaki GE, Chiu RWK, Pertile MD, Sistermans EA, Yaron Y, Vermeesch JR, Vora NL, Best RG, Wilkins-Haug L. International Society for Prenatal Diagnosis Position Statement: cell free (cf)DNA screening for Down syndrome in multiple pregnancies. Prenat Diagn 2020; 41:1222-1232. [PMID: 33016373 DOI: 10.1002/pd.5832] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Rossa W K Chiu
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mark D Pertile
- Victorian Clinical Genetics Services (VCGS), Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Erik A Sistermans
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Medical Center, Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | | | - Neeta L Vora
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert G Best
- University of South Carolina SOM Greenville, Greenville, South Carolina, USA
| | - Louise Wilkins-Haug
- Division of Maternal Fetal Medicine and Reproductive Genetics, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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14
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Dondik Y, Pagidas K, Eklund E, Ngo C, Palomaki GE, Lambert-Messerlian G. Levels of angiogenic markers in second-trimester maternal serum from in vitro fertilization pregnancies with oocyte donation. Fertil Steril 2020; 112:1112-1117. [PMID: 31843087 DOI: 10.1016/j.fertnstert.2019.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine whether differences exist in angiogenic placental growth factor (PlGF) and antiangiogenic soluble vascular endothelial growth factor receptor 1 (sVEGFR-1; both being early markers of placental ischemic disease) in oocyte-donation (OD) pregnancies, compared with autologous in vitro fertilization (aIVF) and spontaneous pregnancies. DESIGN Case-control study of residual second-trimester serum samples from women undergoing prenatal screening. SETTING Academic medical center. PATIENT(S) Fifty-seven OD pregnancies were identified. Each OD pregnancy was matched to two spontaneous pregnancies (n = 114) and one aIVF pregnancy (n = 57). INTERVENTIONS(S) None. MAIN OUTCOME MEASURE(S) Second-trimester serum PlGF and sVEGFR-1 levels. RESULT(S) sVEGFR-1, PlGF, and unconjugated E2 levels were similar among the three study groups. The ratio of sVEGFR-1 to PlGF was significantly higher in the OD group. Consistently with previous studies, alpha-fetoprotein (AFP) in the OD group was significantly elevated compared with spontaneous pregnancy. Both aIVF and OD groups had greater levels of inhibin A than the spontaneous pregnancy group, and the OD group had significantly higher levels of inhibin A than the aIVF group. hCG levels were significantly elevated in aIVF compared with spontaneous pregnancy; however, levels were not different between aIVF and OD. CONCLUSION(S) Second-trimester serum sVEGFR-1 and PlGF levels were not significantly altered in OD pregnancies. Our data support previous findings that OD pregnancies have uniquely increased second-trimester AFP, hCG, and inhibin A levels compared with aIVF. However, the biologic basis of these marker elevations in OD may not be related to placental angiogenesis.
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Affiliation(s)
- Yelena Dondik
- University of Louisville School of Medicine, Louisville, Kentucky.
| | - Kelly Pagidas
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Elizabeth Eklund
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School, Brown University, Providence, Rhode Island
| | - Christina Ngo
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School, Brown University, Providence, Rhode Island
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School, Brown University, Providence, Rhode Island
| | - Geralyn Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School, Brown University, Providence, Rhode Island
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15
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Oktay KH, Bedoschi G, Goldfarb SB, Taylan E, Titus S, Palomaki GE, Cigler T, Robson M, Dickler MN. Increased chemotherapy-induced ovarian reserve loss in women with germline BRCA mutations due to oocyte deoxyribonucleic acid double strand break repair deficiency. Fertil Steril 2020; 113:1251-1260.e1. [PMID: 32331767 DOI: 10.1016/j.fertnstert.2020.01.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether woman who have BRCA mutations (WBM) experience more declines in ovarian reserve after chemotherapy treatment, as it induces oocyte death by deoxyribonucleic acid (DNA) damage, and BRCA mutations result in DNA damage repair deficiency. DESIGN Longitudinal cohort study. SETTING Academic centers. PATIENT(S) The 108 evaluable women with breast cancer were stratified into those never tested (negative family history; n = 35) and those negative (n = 59) or positive (n = 14) for a pathogenic BRCA mutation. INTERVENTION(S) Sera were longitudinally obtained before and 12-24 months after chemotherapy treatment, assayed for antimüllerian hormone (AMH), and adjusted for age at sample collection. MAIN OUTCOME MEASURE(S) Ovarian recovery, defined as the geometric mean of the after chemotherapy age-adjusted AMH levels compared with baseline levels. RESULT(S) Compared with the controls, the before chemotherapy treatment AMH levels were 24% and 34% lower in those negative or positive for BRCA mutations, consistent with accelerated ovarian aging in WBM. The WBM had a threefold difference in AMH recovery after chemotherapy treatment (1.6%), when compared with BRCA negative (3.7%) and untested/low risk controls (5.2%). Limiting the analysis to the most common regimen, doxorubicin and cyclophosphamide followed by paclitaxel, showed similar results. These findings were mechanistically confirmed in an in vitro mouse oocyte BRCA knockdown bioassay, which showed that BRCA deficiency results in increased oocyte susceptibility to doxorubicin. CONCLUSION(S) Women who have pathogenic BRCA mutations are more likely to lose ovarian reserve after chemotherapy treatment, suggesting an emphasis on fertility preservation. Furthermore, our findings generate the hypothesis that DNA repair deficiency is a shared mechanism between aging, infertility, and cancer. CLINICAL TRIAL REGISTRATION NUMBER NCT00823654.
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Affiliation(s)
- Kutluk H Oktay
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| | - Giuliano Bedoschi
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | | | - Enes Taylan
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Shiny Titus
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, Providence, Rhode Island
| | - Tessa Cigler
- Weill Medical College of Cornell University, New York, New York
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, New York
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16
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Palomaki GE, Kalra B, Kumar T, Patel AS, Savjani G, Torchen LC, Dunaif A, Morrison A, Lambert-Messerlian GM, Kumar A. Adjusting antimüllerian hormone levels for age and body mass index improves detection of polycystic ovary syndrome. Fertil Steril 2020; 113:876-884.e2. [PMID: 32147175 DOI: 10.1016/j.fertnstert.2019.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/08/2019] [Accepted: 12/05/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine whether accounting for a woman's age and body mass index (BMI) would improve the ability of antimüllerian hormone (AMH) to distinguish between women with (cases) and without (controls) polycystic ovarian syndrome (PCOS). DESIGN An opportunistic case-control dataset of reproductive age women having evaluations for PCOS as defined by National Institutes of Health criteria. SETTING Two medical centers in the United States enrolled women. Serum samples were analyzed for relevant analytes. PATIENTS Women were between 18 and 39 years of age when samples and clinical information were collected. Residual samples had been stored for 2-17 years. AMH was measured via immunoassay. INTERVENTIONS None; this was an observational study. MAIN OUTCOME MEASURES Detection and false-positive rates for PCOS were computed for AMH results expressed as multiples of the median (MoM) both before and after adjustment for the woman's age and BMI. RESULTS Using unadjusted AMH MoM results, 168 cases (78%) cases were at or beyond the 90th centile of controls (2.47 MoM). After accounting for each woman's age and BMI, 188 (87%) of those women were beyond the 90th centile of controls (2.20 MoM), a significant increase (P = .015). The adjusted AMH MoM levels fitted logarithmic normal distributions well (mean, standard deviation for controls and cases of 0.0000, 0.2765 and 0.6884, 0.2874, respectively) and this allowed for computation of patient-specific PCOS risks. CONCLUSIONS Accounting for the woman's age and BMI resulted in significantly higher AMH-based detection rates for PCOS at a 10% false-positive rate, and patient-specific PCOS risks could be computed.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, Rhode Island; Savjani Institute for Health Research, Windham, Maine.
| | | | | | | | | | - Laura C Torchen
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrea Dunaif
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Chicago, Illinois
| | | | - Geralyn M Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, Rhode Island; Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island
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17
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Palomaki GE, Wyatt P, Best RG, Lepage N, Ashwood ER, Souers RJ, Thorson JA. Assessment of laboratories offering cell-free (cf) DNA screening for Down syndrome: results of the 2018 College of American Pathology External Educational Exercises. Genet Med 2020; 22:777-784. [PMID: 31929509 DOI: 10.1038/s41436-019-0718-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/22/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Summarize and interpret results from exercises distributed to laboratories offering cell-free (cf) DNA screening for Down syndrome. METHODS The College of American Pathologists distributed three patient-derived plasma specimens twice in 2018. Sequencing platforms, test methods, results, and responses to supplemental questions were collected. Results were not graded but discrepancies were identified. RESULTS Sixty-five laboratories from six continents enrolled; six provided no results. The most common methodology was shotgun/genome sequencing (39/56, 70%). Overall, 40% of the gestational or maternal age responses were incorrect but 45% of the errors were corrected by the next distribution. Fetal fractions from 54 responding laboratories generally agreed with the intended response. No genotyping errors occurred (40/40 for trisomy 21 and 226/226 for euploid challenges) but 10 additional tests failed (3.6%). All 213 fetal sex calls were correct. Participants reported their clinical text for a Down syndrome screen positive test; 39% were classified as inadequate or misleading. CONCLUSION Patient-derived materials are suitable for all enrolled technologies/methodologies, but collecting material is challenging. Suggested clinical text includes the terms "screen positive" and "screen negative." Overall, laboratories performed well. Future efforts will focus on potential manufactured samples, clarifying results reporting and including additional chromosome abnormalities.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, USA.
| | - Philip Wyatt
- Esoterix Genetic Laboratories, Santa Fe, NM, USA
| | - Robert Glen Best
- Biomedical Sciences, University of South Carolina School of Medicine/Prisma Health System, Greenville, SC, USA
| | | | - Edward R Ashwood
- University of Colorado Hospital, Anschutz Medical Campus, Aurora, CO, USA
| | - Rhona J Souers
- Department of Biostatistics, College of American Pathologists, Northfield, IL, USA
| | - John A Thorson
- Department of Pathology, University of California San Diego Health, La Jolla, CA, USA
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18
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Palomaki GE, Haddow JE. Comment on "Expanded carrier screening for autosomal recessive conditions in health care: Arguments for a couple-based approach and examination of couples' views". Prenat Diagn 2019; 39:1038. [PMID: 31660643 DOI: 10.1002/pd.5510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/19/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Glenn E Palomaki
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, Providence, RI
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19
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Haddow JE, Metzger BE, Lambert-Messerlian G, Eklund E, Coustan D, Catalano P, Palomaki GE. Maternal BMI, Peripheral Deiodinase Activity, and Plasma Glucose: Relationships Between White Women in the HAPO Study. J Clin Endocrinol Metab 2019; 104:2593-2600. [PMID: 30753726 PMCID: PMC7453035 DOI: 10.1210/jc.2018-02328] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/06/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Explore the maternal body mass index (BMI) relationship with peripheral deiodinase activity further. Examine associations between deiodinase activity, glucose, and C-peptide. Consider findings in the historical context of related existing literature. DESIGN Identify fasting plasma samples and selected demographic, biophysical, and biochemical data from a subset of 600 randomly selected non-Hispanic white women recruited in the Hyperglycemia Adverse Pregnancy Outcomes (HAPO) study, all with glucose tolerance testing [545 samples sufficient to measure TSH, free T4 (fT4), and T3]. Exclude highest and lowest 1% TSH values (535 available for analysis). Assess deiodinase activity by using T3/fT4 ratios. Among women with and without gestational diabetes mellitus (GDM), compare thyroid measurements, C-peptide, and other selected data. Examine relationships independent of GDM status between BMI and thyroid hormones and between thyroid hormones and glucose and C-peptide. RESULTS Levels of BMI, T3/fT4 ratio, and T3 were significantly higher among women with GDM (P = 0.01, 0.005, and 0.001, respectively). Irrespective of GDM status, maternal BMI was associated directly with both T3/fT4 ratio (r = 0.40, P < 0.001) and T3 (r = 0.34, P < 0.001) but inversely with fT4 (r = -0.21, P < 0.001). In turn, fasting thyroid hormone levels (most notably T3/fT4 ratio) were directly associated with maternal glucose [z score sum (fasting, 1, 2 hours); r = 0.24, P < 0.001] and with C-peptide [z score sum (fasting, 1 hour); r = 0.27, P < 0.001]. CONCLUSIONS Higher BMI was associated with increased deiodinase activity, consistent with reports from elsewhere. Increased deiodinase activity, in turn, was associated with higher glucose. Deiodinase activity accounts for a small percentage of z score sum glucose.
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Affiliation(s)
- James E Haddow
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Savjani Institute for Health Research, Windham, Maine
- Correspondence and Reprint Requests: James E. Haddow, MD, Division of Medical Screening & Special Testing, Women & Infants Hospital, 70 Elm Street, Second Floor, Providence, Rhode Island 02903. E-mail:
| | - Boyd E Metzger
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Geralyn Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elizabeth Eklund
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, Rhode Island
| | - Donald Coustan
- Department of Obstetrics and Gynecology, Women & Infants’ Hospital of Rhode Island 02905, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Patrick Catalano
- Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Savjani Institute for Health Research, Windham, Maine
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20
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Oktay K, Bedoschi G, Goldfarb SB, Taylan E, Titus S, Palomaki GE, Cigler T, Robson M, Dickler MN. Abstract PD6-06: Impact of BRCA mutations on chemotherapy-induced loss of ovarian reserve: A prospective longitudinal study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd6-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The BRCA1/2 genes are key members of the ataxia-telangiectasia mutated (ATM)-mediated DNA double strand break (DSB) repair pathway. Recent research showed that germline mutations in these genes result in DNA repair deficiency in oocytes, leading to accelerated ovarian aging as manifested by lower ovarian reserve and earlier age at natural menopause. Because we discovered that oocyte DNA repair is similarly critical in chemotherapy-induced ovarian follicle loss, we hypothesized that women with pathogenic mutations in BRCA1/2 genes may experience larger declines in ovarian reserve after chemotherapy. To gauge the degree of the chemotherapy-induced ovarian damage, we utilized serum anti-mullerian hormone (AMH), which is the most reliable current marker for assessing oocyte reserve.
Methods: Women with early stage breast cancer were enrolled before chemotherapy (Trial registration number: NCT00823654) between January 2009 and November 2017. Sera were obtained at baseline, before the initiation of treatment, and 18 to 24 months after the completion of chemotherapy. Stored sera were assayed at once for anti-mullerian hormone (AMH) and the results were adjusted for the women's age at sample collection. Of the 235 enrolled, 117 evaluable women were stratified into three groups, those never tested (based on NCCN Guidelines V 1.2018 ; n=38) and those negative (n=65) or positive (n=14) for a pathogenic BRCA mutation. Ovarian recovery was defined as the geometric mean of the post chemotherapy age-adjusted AMH levels compared to baseline.
Results: Compared to the lower risk (BRCA-untested) control group, AMH levels averaged 76% and 66% in those negative or positive for BRCA mutations (p=0.078). The geometric mean recoveries for the three groups (not tested, BRCA negative and BRCA positive) were 3.7%, 5.2% and 1.6%, respectively. The mean recovery in the BRCA mutation positive group was about one-third the 4.6% recovery in the other two groups combined (two group ANOVA, p=0.034, F=4.89). Given the potential of the ovarian recovery to be dependent on type of chemotherapy, the data were reanalyzed for all three BRCA groups after restriction to those treated with the AC-T (doxorubicin and cyclophosphamide followed by paclitaxel) regimen. Of the 108 women in the previous analysis, 83 (77%) were treated with AC-T; 25, 46 and 12 women in the three groups, respectively. The geometric mean AMH recoveries for these new groups were 3.2%, 4.7% and 1.3%. When the BRCA mutation positive group was compared with other two groups, the former had significantly worse recovery of serum AMH levels (ANOVA, p=0.044, F=4.2).
Conclusions: These data show that women with breast cancer and pathogenic BRCA mutations have striking liability to chemotherapy-induced ovarian reserve loss and may have to be preferentially counselled on fertility preservation methods. In addition, taken together with the previous data showing that women with BRCA mutations may have accelerated ovarian aging, even unaffected reproductive age individuals may have to be proactive about family building or early preservation of their fertility (Supported by NIH R01HD053112).
Citation Format: Oktay K, Bedoschi G, Goldfarb SB, Taylan E, Titus S, Palomaki GE, Cigler T, Robson M, Dickler MN. Impact of BRCA mutations on chemotherapy-induced loss of ovarian reserve: A prospective longitudinal study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-06.
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Affiliation(s)
- K Oktay
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - G Bedoschi
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - SB Goldfarb
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - E Taylan
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - S Titus
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - GE Palomaki
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - T Cigler
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - M Robson
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - MN Dickler
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
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Abstract
OBJECTIVE To quantify changes in the proportion of women aged 35 and older choosing serum screening for Down's syndrome over time and the effect on false positive and detection rates. METHODS From Rhode Island hospital-based laboratory prenatal screening records (2013-2017) we extracted the test performed (Integrated, Combined, Quadruple), maternal age, and Down's syndrome risk; documented observed changes in maternal age distributions and false positive rates, and modelled the impact of varying proportions of older women choosing screening on each test's performance using the 2015 United States birth cohort as baseline. RESULTS Over five years, observed false positive rates for Integrated testing declined from 1.9 to 1.3% (-32%). The proportion of older women tested declined from 14.9 to 8.5%, from which modelling predicts a 16% decline in the false positive rate. This is lower than our observed change but consistent with a reduction driven by declining participation by older women. Modelling predicted a detection rate reduction from 89 to 87%. Larger detection rate impacts were predicted for Combined and Quadruple testing. CONCLUSIONS This study documents, for the first time, the declining proportion of older women choosing Down's syndrome serum screening and subsequent impact on screening performance. The American College of Obstetrics and Gynecology recommends offering cell-free DNA screening for these 'high risk' pregnancies and uptake may increase further. Screening programmes could consider increasing use of Integrated testing over other serum screening tests or lowering risk cut-offs so false positive rates approach those of 2012 to regain lost detection.
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Affiliation(s)
- Geralyn Lambert-Messerlian
- 1 Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, USA.,2 Obstetrics and Gynecology, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, USA
| | - Glenn E Palomaki
- 1 Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, USA
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Palomaki GE, Martin JN, Karumanchi SA, Poon LC. Updates on Screening, Prevention, Treatment, and Genetic Markers for Preeclampsia. Clin Chem 2018; 64:1684-1689. [PMID: 30201802 DOI: 10.1373/clinchem.2018.289801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/30/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Glenn E Palomaki
- Professor of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, RI;
| | - James N Martin
- Professor Emeritus of Obstetrics, Gynecology & Maternal-Fetal Medicine, The University of Mississippi Medical Center, Jackson, MS
| | - S Ananth Karumanchi
- Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA
| | - Liona C Poon
- Associate Professor of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR
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Palomaki GE, Kloza EM. Prenatal cell-free DNA screening test failures: a systematic review of failure rates, risks of Down syndrome, and impact of repeat testing. Genet Med 2018; 20:1312-1323. [PMID: 30514979 DOI: 10.1038/gim.2018.22] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/19/2018] [Indexed: 01/12/2023] Open
Abstract
PURPOSE We systematically reviewed the published literature on test failure rates for the sequencing of cell-free DNA (cfDNA) in maternal plasma to identify Down syndrome. METHODS We searched peer-reviewed English publications with diagnostic results on all pregnancies that provided test failure rates. Data on the odds of failure in Down syndrome and euploid pregnancies and the impact of repeat testing were extracted. Random-effects modeling was then used to identify moderators that could explain variability. RESULTS Thirty articles satisfied the inclusion criteria for overall failure rates. Study location (Western and Asian with initial testing, and Western with repeat testing) were significant moderators with failure rates of 3.3, 0.6, and 1.2%, respectively (P = 0.001). The odds ratio for Down syndrome in successful versus failed tests was 0.98 (95% confidence interval: 0.62-1.55, I2 = 0%). Repeat testing from 14 large clinical cohort studies found that 83% (range: 52-100%) of failures were repeated, with 79% (range: 46-97%) being successful. CONCLUSION Lower failure rates in Asian studies may be related to not routinely measuring the fetal fraction and to fewer obese women. Repeat cfDNA testing is effective in providing reliable results after initial failures. Protocols for primary cfDNA screening should focus on Down syndrome, with less common and more structurally abnormal trisomy 18 and 13 pregnancies treated as adjuncts.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, Rhode Island, USA. .,Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University, Providence, Rhode Island, USA.
| | - Edward M Kloza
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, Rhode Island, USA
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24
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Rehfeldt M, Eklund E, Struck J, Sparwasser A, O'Brien B, Palomaki GE, Köhrle J, Bergmann A, Lambert-Messerlian G. Relaxin-2 connecting peptide (pro-RLX2) levels in second trimester serum samples to predict preeclampsia. Pregnancy Hypertens 2017; 11:124-128. [PMID: 29133069 DOI: 10.1016/j.preghy.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Preeclampsia is a serious complication of pregnancy, threatening fetal and maternal health. The aim of our study is to examine the association between preeclampsia and the connecting peptide of the pregnancy hormone relaxin (pro-RLX2) as a potential new biochemical marker. STUDY DESIGN This is a nested case/control study derived from the cohort of pregnancies delivering at Women & Infants Hospital. Cases were identified at a clinic or by hospital codes, and individually confirmed by record review. Stored samples were available from 'integrated' Down syndrome screening. Results were expressed as multiples of the median (MoM). MAIN OUTCOME MEASURES Preeclampsia was classified as early/severe, late/severe, or mild based on professional guidelines. RESULTS Fifty-one cases were each matched with five control pregnancies. Population distribution parameters were derived for cases and controls. As shown previously, discrimination between cases and controls (applying MoM analysis) was possible for PlGF (0.576, p < .05), inhibin A (1.45, p < .05) and endoglin (1.278, p < .05). No association with preeclampsia was found for pro-RLX2. However, pro-RLX2 correlates with Inhibin A and Endoglin. CONCLUSIONS Endoglin, Inhibin A and PlGF are highly predictive of preeclampsia. Quantification of pro-RLX2 is not able to predict preeclampsia. Nevertheless, the potential involvement of relaxin 2/pro-RLX2 in the pathophysiology of preeclampsia requires further study.
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Affiliation(s)
| | | | | | | | | | | | - Josef Köhrle
- Charité-Universitätsmedizin Berlin, CVK, Berlin, Germany
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25
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Haddow JE, Lambert-Messerlian G, Eklund E, Neveux LM, Palomaki GE. Peripheral deiodinase activity: A potential explanation for the association between maternal weight and gestational hyperglycemia. Obstet Med 2017; 11:73-78. [PMID: 29997689 DOI: 10.1177/1753495x17733223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/23/2017] [Indexed: 12/20/2022] Open
Abstract
Background High maternal weight is known to associate with both low free thyroxine and gestational diabetes mellitus. We explore a deiodinase-related mechanism that may help explain these associations. Methods Among 108 women receiving routine oral glucose tolerance testing for gestational diabetes mellitus, we collected biophysical data and measured free thyroxine and total triiodothyronine, using residual plasma samples. Results Fasting triiodothyronine/free thyroxine ratio and triiodothyronine were higher among women with gestational diabetes mellitus (p = 0.02; p = 0.04). The triiodothyronine/free thyroxine ratio and triiodothyronine measurements at 2 h were associated with weight (r = 0.20, p = 0.04; r = 0.22, p = 0.02); free thyroxine showed a non-significant inverse weight relationship (r = -0.06, p = 0.55). Glucose at all four intervals was associated with triiodothyronine/free thyroxine ratios, and triiodothyronine at 2 h. In stepwise regression, triiodothyronine/free thyroxine ratio predicted glucose more strongly than did weight. Conclusion These relationships may be explained by higher maternal weight inducing peripheral deiodinase activity, resulting in higher plasma glucose (via triiodothyronine stimulation) and thereby increasing gestational diabetes mellitus risk.
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Affiliation(s)
- James E Haddow
- Department of Pathology and Laboratory Medicine, Division of Medical Screening and Special Testing, Women and Infants Hospital/Alpert Medical School of Brown University, Providence, RI, USA.,Savjani Institute for Health Research, Windham, ME, USA
| | - Geralyn Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Division of Medical Screening and Special Testing, Women and Infants Hospital/Alpert Medical School of Brown University, Providence, RI, USA
| | - Elizabeth Eklund
- Department of Pathology and Laboratory Medicine, Division of Medical Screening and Special Testing, Women and Infants Hospital/Alpert Medical School of Brown University, Providence, RI, USA
| | - Louis M Neveux
- Department of Pathology and Laboratory Medicine, Division of Medical Screening and Special Testing, Women and Infants Hospital/Alpert Medical School of Brown University, Providence, RI, USA.,Savjani Institute for Health Research, Windham, ME, USA
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Division of Medical Screening and Special Testing, Women and Infants Hospital/Alpert Medical School of Brown University, Providence, RI, USA.,Savjani Institute for Health Research, Windham, ME, USA
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Lambert-Messerlian GM, Straseski JA, Eklund EE, Palomaki GE, Haddow JE. Antimüllerian Hormone Levels Are Not Altered by Glucose Challenge or a Meal. J Appl Lab Med 2017; 2:238-243. [PMID: 32630977 DOI: 10.1373/jalm.2017.023622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/08/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Measurement of antimüllerian hormone (AMH) is used to assess ovarian reserve. Circulating levels of AMH correlate with antral follicle count, with relatively high levels indicating an ample reserve of primary and preantral follicles in the ovary. AMH levels are stable with dilution and freezer storage, and are not altered by hemolysis or menstrual cycle day in young women of reproductive age. We sought to examine whether glucose challenge or food intake modifies AMH levels compared with fasting. METHODS Residual plasma samples were available from 54 pregnant women under fasting conditions and then 1, 2, and 3 h after ingestion of a 100-g glucose challenge. These samples were collected as part of routine clinical care to identify gestational diabetes (GDM) at 24-28 weeks of gestation. Twelve of these women met criteria for GDM based on an increased glucose level at a minimum of 2 time points. A second set consisted of serum samples collected from 8 nonpregnant women at fasting and 1 h after a meal. Levels of AMH were measured using an ultrasensitive assay (Ansh Labs, Webster, TX). A 2-way ANOVA (sample timing and GDM status) or matched t-test was performed. AMH measurements were subject to a logarithmic transformation before analysis. RESULTS Median AMH levels in pregnant women at 1, 2, or 3 h after glucose challenge did not differ compared with AMH levels at fasting or by diagnosis of GDM. Similarly, there was no difference in median AMH levels in nonpregnant women of reproductive age at fasting and after a meal. CONCLUSION AMH levels are not altered by glucose or food intake.
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Affiliation(s)
- Geralyn M Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School at Brown University, Providence, RI.,Department of Obstetrics and Gynecology, Women and Infants Hospital and Alpert Medical School at Brown University, Providence, RI
| | | | - Elizabeth E Eklund
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School at Brown University, Providence, RI
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School at Brown University, Providence, RI
| | - James E Haddow
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School at Brown University, Providence, RI
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27
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Oglesbee D, Cowan TM, Pasquali M, Wood TC, Weck KE, Long T, Palomaki GE. CAP/ACMG proficiency testing for biochemical genetics laboratories: a summary of performance. Genet Med 2017; 20:83-90. [PMID: 28661487 PMCID: PMC5763156 DOI: 10.1038/gim.2017.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/31/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Testing for inborn errors of metabolism is performed by clinical laboratories worldwide, each utilizing laboratory-developed procedures. We sought to summarize performance in the College of American Pathologists’ (CAP) proficiency testing (PT) program and identify opportunities for improving laboratory quality. When evaluating PT data, we focused on a subset of laboratories that have participated in at least one survey since 2010. Methods An analysis of laboratory performance (2004 to 2014) on the Biochemical Genetics PT Surveys, a program administered by CAP and the American College of Medical Genetics and Genomics. Analytical and interpretive performance was evaluated for four tests: amino acids, organic acids, acylcarnitines, and mucopolysaccharides. Results Since 2010, 150 laboratories have participated in at least one of four PT surveys. Analytic sensitivities ranged from 88.2 to 93.4%, while clinical sensitivities ranged from 82.4 to 91.0%. Performance was higher for US participants and for more recent challenges. Performance was lower for challenges with subtle findings or complex analytical patterns. Conclusion US clinical biochemical genetics laboratory proficiency is satisfactory, with a minority of laboratories accounting for the majority of errors. Our findings underscore the complex nature of clinical biochemical genetics testing and highlight the necessity of continuous quality management.
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Affiliation(s)
- Devin Oglesbee
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Tina M Cowan
- Department of Pathology, Stanford University, School of Medicine, Palo Alto, California, USA
| | - Marzia Pasquali
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Timothy C Wood
- Greenwood Genetics Center, Greenwood, South Carolina, USA
| | - Karen E Weck
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thomas Long
- Department of Biostatistics, College of American Pathologists, Northfield, Illinois, USA
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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28
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Bradley LA, Haddow HRM, Palomaki GE. Treatment of mucopolysaccharidosis type II (Hunter syndrome): results from a systematic evidence review. Genet Med 2017. [PMID: 28640238 DOI: 10.1038/gim.2017.30] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PurposeA pilot systematic evidence review to establish methodology utility in rare genetic diseases, support clinical recommendations, and identify important knowledge gaps.MethodsBroad-based published/gray-literature searches through December 2015 for studies of males with confirmed mucopolysaccharidosis type II (any age, phenotype, genotype, family history) treated with enzyme replacement therapy or hematopoietic stem cell transplantation. Preset inclusion criteria employed for abstract and full document selection, and standardized methods for data extraction and assessment of quality and strength of evidence.ResultsTwelve outcomes reported included benefits of urinary glycosaminoglycan and liver/spleen volume reductions and harms of immunoglobulin G/neutralizing antibody development (moderate strength of evidence). Less clear were benefits of improved 6-minute walk tests, height, early treatment, and harms of other adverse reactions (low strength of evidence). Benefits and harms of other outcomes were unclear (insufficient strength of evidence). Current benefits and harms of hematopoietic stem cell transplantation are unclear, based on dated, low-quality studies. A critical knowledge gap is long-term outcomes. Consensus on selection of critical outcomes and measures is needed to definitively evaluate treatment safety and effectiveness.ConclusionMinor methodology modifications and a focus on critical evidence can reduce review time and resources. Summarized evidence was sufficient to support guidance development and highlight important knowledge gaps.
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Affiliation(s)
- Linda A Bradley
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Warren Alpert, Medical School at Brown University, Providence, Rhode Island, USA
| | | | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Warren Alpert, Medical School at Brown University, Providence, Rhode Island, USA
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29
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Korpi-Steiner N, Chiu RWK, Chandrasekharan S, Chitty LS, Evans MI, Jackson JA, Palomaki GE. Emerging Considerations for Noninvasive Prenatal Testing. Clin Chem 2017; 63:946-953. [DOI: 10.1373/clinchem.2016.266544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/27/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Nichole Korpi-Steiner
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC
| | - Rossa W K Chiu
- Centre for Research into Circulating Fetal Nucleic Acids, Li Ka Shing Institute of Health Sciences and Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Lyn S Chitty
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street NHS Foundation Trust, London, UK
| | - Mark I Evans
- Department of Obstetrics and Gynecology, Mt. Sinai School of Medicine, New York, NY
- Comprehensive Genetics and Fetal Medicine Foundation of America, New York, NY
| | - Judith A Jackson
- South Shore Hospital, South Weymouth, MA
- Brandeis University, Waltham, MA
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Alpert Medical School at Brown University, Providence, RI
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30
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O'Brien BM, Halliday J, Lambert-Messerlian G, Eklund EE, Kloza E, Palomaki GE. Nuchal translucency measurement in the era of prenatal screening for aneuploidy using cell free (cf)DNA. Prenat Diagn 2017; 37:303-305. [PMID: 28124379 DOI: 10.1002/pd.5010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Barbara M O'Brien
- Department of Obstetrics and Gynecology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, USA
| | - Jacquelyn Halliday
- Department of Obstetrics and Gynecology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, USA
| | - Geralyn Lambert-Messerlian
- Department of Obstetrics and Gynecology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, USA.,Department of Pathology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, USA
| | - Elizabeth E Eklund
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, USA
| | - Edward Kloza
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, USA
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, USA
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31
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Lee J, Eklund EE, Lambert-Messerlian G, Palomaki GE, Butterfield K, Curran P, Bourjeily G. Serum Progesterone Levels in Pregnant Women with Obstructive Sleep Apnea: A Case Control Study. J Womens Health (Larchmt) 2017; 26:259-265. [PMID: 28103130 DOI: 10.1089/jwh.2016.5917] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pregnancy is a risk factor for sleep disordered breathing, including obstructive sleep apnea (OSA). Progesterone, one of the key hormones in pregnancy, a known respiratory drive stimulant, increases ventilation and may protect against OSA. We aimed to examine the relationship between circulating progesterone and OSA, after accounting for body weight and gestational age. METHODS A case control study was conducted of pregnant women with OSA and those at low risk for the disorder. Cases were identified by ICD-9 code and review of medical record. Controls were identified if they scored zero (never) for snoring, apnea, and gasping on the multivariable apnea prediction index questionnaire immediately following delivery. Subjects with available stored first and/or second trimester residual serum samples were then included in this study and serum analyzed for progesterone. Raw progesterone levels were adjusted for the effects of gestational age and maternal weight. RESULTS Twenty-seven cases and 64 controls with available serum were identified. Women with OSA had greater maternal weight and higher rates of related comorbidities, compared to controls. Progesterone levels correlated positively with gestational age and negatively with greater weight. Progesterone levels, adjusted for gestational age and maternal weight and expressed as multiples of median (MoM), were significantly lower in OSA cases compared to controls in both the first trimester (MoM = 0.71, confidence interval [95% CI] 0.60-0.83) relative to the MoM in controls of 1.00. In the second trimester levels were also lower in OSA cases (MoM = 0.84, 95% CI 0.73-0.96) compared to the MoM of 1.00 in controls. CONCLUSIONS Progesterone levels, after accounting for weight and gestational age, were lower in women with OSA than controls. Progesterone may play a protective role against OSA.
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Affiliation(s)
- Jennifer Lee
- 1 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island
| | - Elizabeth E Eklund
- 2 Department of Pathology and Laboratory Medicine, Women & Infants Hospital of Rhode Island , Providence, Rhode Island
| | - Geralyn Lambert-Messerlian
- 1 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island.,2 Department of Pathology and Laboratory Medicine, Women & Infants Hospital of Rhode Island , Providence, Rhode Island
| | - Glenn E Palomaki
- 1 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island.,2 Department of Pathology and Laboratory Medicine, Women & Infants Hospital of Rhode Island , Providence, Rhode Island
| | - Kristen Butterfield
- 3 Department of Clinical and Academic Quality Initiatives, Rhode Island Hospital , Providence, Rhode Island
| | - Patrizia Curran
- 4 Women's Medicine Collaborative, The Miriam Hospital , Providence, Rhode Island
| | - Ghada Bourjeily
- 1 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island.,4 Women's Medicine Collaborative, The Miriam Hospital , Providence, Rhode Island.,5 Department of Medicine, The Miriam Hospital , Providence, Rhode Island
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Palomaki GE, Kloza EM, O'Brien BM, Eklund EE, Lambert-Messerlian GM. The clinical utility of DNA-based screening for fetal aneuploidy by primary obstetrical care providers in the general pregnancy population. Genet Med 2017; 19:778-786. [PMID: 28079901 PMCID: PMC5532959 DOI: 10.1038/gim.2016.194] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/28/2016] [Indexed: 01/22/2023] Open
Abstract
Objective: To assess the clinical utility of cell-free DNA (cfDNA)-based screening for
aneuploidies offered through primary obstetrical care providers to a general
pregnancy population. Methods: Patient educational materials were developed and validated and providers were
trained. Serum was collected for reflexive testing of cfDNA failures.
Providers and patients were surveyed concerning knowledge, decision making,
and satisfaction. Pregnancy outcome was determined by active or passive
ascertainment. Results: Between September 2014 and July 2015, 72 providers screened 2,691 women. The
five largest participating practices increased uptake by 8 to 40%. Among
2,681 reports, 16 women (0.6%) were screen-positive for trisomy 21, 18, or
13; all saw genetic professionals. Twelve were confirmed (positive
predictive value (PPV), 75%; 95% CI, 48–93%) and four were
false-positives (0.15%). Of 150 failures (5.6%), 79% had a negative serum or
subsequent cfDNA test; no aneuploidies were identified. Of 100 women
surveyed, 99 understood that testing was optional, 96 had their questions
answered, and 95 received sufficient information. Pretest information was
provided by the physician/certified nurse midwife (55) or office
nurse/educator (40); none was provided by genetic professionals. Conclusion: This first clinical utility study of cfDNA screening found higher uptake
rates, patient understanding of basic concepts, and easy incorporation into
routine obstetrical practices. There were no reported cases of aneuploidy
among cfDNA test failures. Genet Med advance online publication 12 January 2017
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women &Infants Hospital, Providence, Rhode Island, USA.,Department of Pathology and Laboratory Medicine, Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | - Edward M Kloza
- Department of Pathology and Laboratory Medicine, Women &Infants Hospital, Providence, Rhode Island, USA
| | - Barbara M O'Brien
- Department of Obstetrics and Gynecology, Women &Infants Hospital, Providence, Rhode Island, USA.,Current affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Elizabeth E Eklund
- Department of Pathology and Laboratory Medicine, Women &Infants Hospital, Providence, Rhode Island, USA
| | - Geralyn M Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women &Infants Hospital, Providence, Rhode Island, USA.,Department of Pathology and Laboratory Medicine, Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.,Department of Obstetrics and Gynecology, Women &Infants Hospital, Providence, Rhode Island, USA
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Knight GJ, Palomaki GE, Neveux LM, Haddow JE, Lambert-Messerlian GM. Clinical validation of a new dimeric inhibin-A assay suitable for second trimester Down's syndrome screening. J Med Screen 2016; 8:2-7. [PMID: 11373844 DOI: 10.1136/jms.8.1.2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the Down's syndrome screening performance of a simplified dimeric inhibin-A assay (Diagnostic Systems Laboratories (DSL)) with an assay whose clinical utility has been established (Serotec). Setting A case control set consisting of 51 Down's syndrome and 245 matched unaffected pregnancies collected as part of an earlier multicentre cohort study. Methods Sera were assayed for dimeric inhibin-A using the DSL assay and Serotec reference assay. Data analysis included a method comparison of mass values, fit of data to a logarithmic Gaussian distribution, and determination of detection and false positive rates. In addition, 234 fresh sera were assayed using the simplified method. Results The two assays showed a high correlation (r =0.93) but average concentrations of the DSL assay were 48% higher. However, the differences were basically proportional over the range of values important for screening. The detection rate was essentially equivalent for the DSL assay whether analysed univariately or in combination with other markers (for example, 79% v 75% at a 5% false positive rate for the DSL and Serotec assays for the combination of α fetoprotein, unconjugated oestriol, human chorionic gonadotrophin, and dimeric inhibin-A, respectively). The 234 dimeric inhibin-A values measured on fresh sera fitted a logarithm Gaussian distribution for the DSL assay, as indicated by the fit to a probability plot. Conclusions The Down's syndrome screening performance of a simplified dimeric inhibin-A immunoassay was equivalent to a more labour intensive established dimeric inhibin-A assay.
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Affiliation(s)
- G J Knight
- Foundation for Blood Research, Scarborough, Maine 04070-0190, USA.
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Palomaki GE, Lambert-Messerlian GM, Haddow JE. Where have all the trisomies gone? Am J Obstet Gynecol 2016; 215:583-587.e1. [PMID: 27793310 DOI: 10.1016/j.ajog.2016.06.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/15/2016] [Accepted: 06/23/2016] [Indexed: 10/20/2022]
Abstract
Providing reliable prenatal screening performance estimates is critical for patient counseling and policy-making. Women who choose prenatal screening for aneuploidy are likely to be concerned not only with the common aneuploidies but with all causes of intellectual disability and serious birth defects. Sequential prenatal screening (combined serum and ultrasound testing) for aneuploidy detection commonly is offered as a primary screening test. Among women identified as screen positive, cell-free (cf)DNA has been added recently as a secondary, noninvasive screening option, before the consideration of invasive diagnostic testing (eg, amniocentesis and karyotype). With the anticipation of lower costs in the future, cfDNA might be an alternative to sequential screening in the general population. Sequential and cfDNA tests are both noninvasive, and both identify common aneuploidies. Screening via cfDNA detects more common chromosome abnormalities (eg, trisomy 21, sex trisomies). Sequential screening can identify other aneuploidies (eg, triploidy), as well as chromosome abnormalities associated with fetal structural abnormalities. When the advantages and disadvantages of routine sequential screening with routine cfDNA screening are compared, one important measure is the proportion and severity of chromosome abnormalities identified. When reporting these detection rates, authors need to carefully consider the impact of multiple well-described biases. For women to make informed choices in situations of this type, determining reliable comparative performance estimates is crucial.
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Lambert-Messerlian GM, Eklund EE, Neveux LM, Palomaki GE. Measuring maternal serum screening markers for Down's syndrome in plasma collected for cell-free DNA testing. J Med Screen 2016; 24:113-119. [PMID: 28756761 DOI: 10.1177/0969141316670193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To determine whether maternal plasma collected in cell-free DNA stabilizing tubes is suitable for measuring prenatal screening 'serum' markers. Methods Matched plasma and serum samples were collected from 41 second trimester and 42 first trimester non-Down's syndrome pregnancies. Second trimester samples were tested for alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin, and inhibin-A (Beckman Coulter DxI immunoassay). First trimester samples were tested for human chorionic gonadotropin and pregnancy-associated plasma protein A. Method comparisons performed for each marker compared plasma and serum results. Down's syndrome likelihood ratios in serum and plasma were compared. Results Plasma and serum results for all markers were highly correlated ( r > 0.983) but for all, plasma results differed, usually by proportional amounts. After conversion to multiples of the median using sample type-specific medians, the logarithmic standard deviations in serum and plasma did not differ (all p > 0.37). Likelihood ratios for the first and second trimester marker combinations were highly correlated and closely agreed (log likelihood ratios range 1.005 to 1.032; 1.000 indicates complete agreement). Conclusions These results using specialized plasma collection tubes are similar to those of our earlier study showing that plasma collected in EDTA tubes is suitable for 'serum' Down's syndrome screening. Laboratories must account for proportional changes by computing new plasma medians or modifying existing serum medians. Using a portion of the plasma from cell-free DNA collection tubes for 'serum screening' may have an advantage in programmes that are reflexively testing cell-free DNA, as only one sample type need be collected.
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Affiliation(s)
- Geralyn M Lambert-Messerlian
- 1 Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Providence, RI, USA.,2 Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - Elizabeth E Eklund
- 1 Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Providence, RI, USA
| | - Louis M Neveux
- 1 Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Providence, RI, USA
| | - Glenn E Palomaki
- 1 Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Providence, RI, USA.,2 Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, RI, USA
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Palomaki GE, Haddow JE. Confusion between analytic validity and clinical validity. Am J Obstet Gynecol 2016; 215:533-4. [PMID: 27316786 DOI: 10.1016/j.ajog.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
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Lambert-Messerlian G, Halliday J, Williams J, Cain R, Msall ME, Palomaki GE, Canick JA. Effect of folic acid fortification on prevalence of neural tube defects in Rhode Island. J Med Screen 2016; 11:106-7. [PMID: 15153328 DOI: 10.1258/096914104774061119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Haddow JE, Craig WY, Neveux LM, Palomaki GE, Lambert-Messerlian G, Malone FD, D’Alton ME. Free Thyroxine During Early Pregnancy and Risk for Gestational Diabetes. PLoS One 2016; 11:e0149065. [PMID: 26910563 PMCID: PMC4766100 DOI: 10.1371/journal.pone.0149065] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/27/2016] [Indexed: 01/29/2023] Open
Abstract
Several studies have now reported associations between gestational diabetes mellitus (GDM) and low free thyroxine (fT4) during the second and third trimesters, but not in the first trimester. The present study further examines relationships between low fT4, maternal weight, and GDM among women in the FaSTER (First and Second Trimester Evaluation of Risk) trial, in an effort to determine the extent to which thyroid hormones might contribute to causality. The FaSTER cohort includes 9351 singleton, euthyroid women; 272 of these women were subsequently classified as having GDM. Thyrotropin (TSH), fT4, and thyroid antibodies were measured at 11–14 weeks’ gestation (first trimester) and 15–18.9 weeks’ gestation (second trimester). An earlier report of this cohort documented an inverse relationship between fT4 in the second trimester and maternal weight. In the current analysis, women with GDM were significantly older (32 vs. 28 years) and weighed more (75 vs. 64.5 kg). Maternal weight and age (but not TSH) were significantly associated univariately with fT4 (dependent variable), in the order listed. Second trimester fT4 odds ratios (OR) for GDM were 2.06 [95% CI 1.37–3.09] (unadjusted); and 1.89 [95% CI 1.26–2.84] (adjusted). First trimester odds ratios were not significant: OR 1.45 [95%CI 0.97–2.16] (unadjusted) and 1.11 [95% CI 0.74–1.62] (adjusted). The second trimester fT4/GDM relationship thus appeared to strengthen as gestation progressed. In FaSTER, high maternal weight was associated with both low fT4 and a higher GDM rate in the second trimester. Peripheral deiodinase activity is known to increase with high caloric intake (represented by high weight). We speculate that weight-related low fT4 (the metabolically inactive prohormone) is a marker for deiodinase activity, serving as a substrate for conversion of fT4 to free triiodothyronine (fT3), the active hormone responsible for glucose-related metabolic activity.
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Affiliation(s)
- James E. Haddow
- Department of Pathology and Laboratory Medicine, Division of Medical Screening and Special Testing, Women and Infants Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Savjani Institute for Health Research, Windham, Maine, United States of America
- * E-mail:
| | - Wendy Y. Craig
- Maine Medical Center Research Institute, Scarborough, Maine, United States of America
| | - Louis M. Neveux
- Department of Pathology and Laboratory Medicine, Division of Medical Screening and Special Testing, Women and Infants Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Savjani Institute for Health Research, Windham, Maine, United States of America
| | - Glenn E. Palomaki
- Department of Pathology and Laboratory Medicine, Division of Medical Screening and Special Testing, Women and Infants Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Savjani Institute for Health Research, Windham, Maine, United States of America
| | - Geralyn Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Division of Medical Screening and Special Testing, Women and Infants Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Fergal D. Malone
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University College of Physicians and Surgeons, New York, New York, United States of America
- Department of Obstetrics & Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland, United Kingdom
| | - Mary E. D’Alton
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University College of Physicians and Surgeons, New York, New York, United States of America
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Lambert-Messerlian G, Palomaki GE. Prenatal serum screening markers may not require adjustment in former smokers. Prenat Diagn 2015; 35:1371-3. [PMID: 26413989 DOI: 10.1002/pd.4695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/08/2015] [Accepted: 09/20/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Geralyn Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School of Brown University, Providence, RI, USA
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Haddow JE, Neveux LM, Palomaki GE, Lambert-Messerlian G, Malone FD, D'Alton ME. An Inverse Relationship Between Weight and Free Thyroxine During Early Gestation Among Women Treated for Hypothyroidism. Thyroid 2015; 25:949-53. [PMID: 26061605 PMCID: PMC4533030 DOI: 10.1089/thy.2015.0085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Following treatment sufficient to normalize thyrotropin (TSH), nonpregnant hypothyroid adults display higher free thyroxine (FT(4)) concentrations than a reference population. Our aim is to determine whether FT(4) concentrations are higher during pregnancy among women treated for hypothyroidism and whether their weight is associated with FT(4) levels. Weight/FT(4) relationships have not previously been reported in treated hypothyroid adults (either pregnant or nonpregnant). METHODS Thyroid-related measurements were available from over 10,000 women at two early pregnancy time periods from the FaSTER (First and Second Trimester Evaluation of Risk for Fetal aneuploidy) trial (1999-2002). All women were receiving routine prenatal care. Present analyses were restricted to 9267 reference women and 306 treated, hypothyroid women with TSH between the 2nd and 98th reference percentiles. We compared FT(4) values between those groups at 11-14 and 15-18 weeks' gestation, using linear regression to estimate FT(4)/maternal weight relationships, after accounting for treatment and other potential covariates. RESULTS In comparison to reference women, median FT(4) values and percent of FT(4) values ≥95th reference percentile were significantly higher in treated women at both 11-14 and 15-18 weeks' gestation (p<0.001) overall and after stratification by weight into tertiles. Among both treated and reference women, median FT(4) decreased monotonically with increasing weight, regardless of anti-thyroperoxidase antibody status. Maternal age, maternal weight, and treatment status were important predictors of FT(4) levels (p<0.001, defined by partial r(2) values of 1% or higher). Anti-thyroperoxidase antibody status, TSH values (after logarithmic transformation), and all interaction terms were well below an r(2) of 1%. FT(4) levels were 1.45 pmol/L higher in treated than reference women, independent of other factors. Maternal age and weight reduced FT(4) levels by 0.0694 pmol/L/y and 0.0208 pmol/L/kg, respectively. CONCLUSIONS FT(4) concentrations are higher among treated hypothyroid pregnant women than among reference women, and higher maternal weight is associated with lower FT(4) levels, regardless of treatment status. This inverse relationship is not associated with higher TSH levels. While no immediate clinical implications are attached to the current observations, increased peripheral deiodinase activity in the presence of higher weight might explain these findings. Further investigation appears worthy of attention.
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Affiliation(s)
- James E. Haddow
- Women and Infants Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
- Savjani Institute for Health Research, Windham, Maine
| | - Louis M. Neveux
- Women and Infants Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
- Savjani Institute for Health Research, Windham, Maine
| | - Glenn E. Palomaki
- Women and Infants Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
- Savjani Institute for Health Research, Windham, Maine
| | | | - Fergal D. Malone
- University College of Physicians and Surgeons, New York, New York
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary E. D'Alton
- University College of Physicians and Surgeons, New York, New York
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Palomaki GE, Eklund EE, Neveux LM, Lambert Messerlian GM. Evaluating first trimester maternal serum screening combinations for Down syndrome suitable for use with reflexive secondary screening via sequencing of cell free DNA: high detection with low rates of invasive procedures. Prenat Diagn 2015; 35:789-96. [PMID: 25967109 DOI: 10.1002/pd.4609] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Examine primary Down syndrome screening using combinations of first trimester serum markers, with and without sequencing of cell free DNA as a secondary reflexive test. METHODS Samples from 40 Down syndrome cases were matched with five control samples and tested for PAPP-A, free β, AFP, inhibin-A and PlGF. Results were converted to weight-adjusted multiples of the median (MoM) and population parameters computed. Monte Carlo simulation modeled Down syndrome detection and false positive rates for various marker combinations. After reflexive DNA testing, the revised detection and false positive rates were also computed. RESULTS At a primary false positive rate of 20%, the baseline combination (maternal age, PAPP-A and free β) detected 86.9%. Adding AFP or PlGF increased detection to 89.8% and 89.5%, respectively. Adding AFP and PlGF, AFP and inhibin-A, or all three markers, detected 93.7%, 94.1% and 95.5%, respectively. Modeling reflexive cf DNA testing results in little loss in detection (1%), but false positive rates fall to 0.2%. CONCLUSION First trimester reflexive testing does not require nuchal translucency measurements, and has high detection and very low rates of invasive procedures. However, timing of DNA sample collection and the costs of sample collection and DNA testing need to be considered before implementation.
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Affiliation(s)
- Glenn E Palomaki
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA.,Department of Pathology and Laboratory Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Elizabeth E Eklund
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Louis M Neveux
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Geralyn M Lambert Messerlian
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA.,Department of Pathology and Laboratory Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
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Palomaki GE. Screening for breast cancer by molecular testing for three founder mutations in the BRCA1 and BRCA2 genes among women of Ashkenazi Jewish heritage. J Med Screen 2015; 22:109-11. [DOI: 10.1177/0969141315579701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Glenn E. Palomaki
- Department of Pathology and Laboratory Medicine
- Women & Infants Hospital/Alpert Medical School at Brown University
- Providence, Rhode Island, USA
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Palomaki GE, Haddow JE, Haddow HRM, Salahuddin S, Geahchan C, Cerdeira AS, Verlohren S, Perschel FH, Horowitz G, Thadhani R, Karumanchi SA, Rana S. Modeling risk for severe adverse outcomes using angiogenic factor measurements in women with suspected preterm preeclampsia. Prenat Diagn 2015; 35:386-93. [PMID: 25641027 PMCID: PMC4409832 DOI: 10.1002/pd.4554] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/13/2014] [Accepted: 12/23/2014] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Preeclampsia (PE) is a pregnancy-specific syndrome associated with adverse maternal and fetal outcomes. Patient-specific risks based on angiogenic factors might better categorize those who might have a severe adverse outcome. METHODS Women evaluated for suspected PE at a tertiary hospital (2009-2012) had pregnancy outcomes categorized as 'referent' or 'severe', based solely on maternal/fetal findings. Outcomes that may have been influenced by a PE diagnosis were considered 'unclassified'. Soluble fms-like tyrosine kinase (sFlt1) and placental growth factor (PlGF) were subjected to bivariate discriminant modeling, allowing patient-specific risks to be assigned for severe outcomes. RESULTS Three hundred twenty-eight singleton pregnancies presented at ≤34.0 weeks' gestation. sFlt1 and PlGF levels were adjusted for gestational age. Risks above 5 : 1 (10-fold over background) occurred in 77% of severe (95% CI 66 to 87%) and 0.7% of referent (95% CI <0.1 to 3.8%) outcomes. Positive likelihood ratios for the modeling and validation datasets were 19 (95% CI 6.2-58) and 15 (95% CI 5.8-40) fold, respectively. CONCLUSIONS This validated model assigns patient-specific risks of any severe outcome among women attending PE triage. In practice, women with high risks would receive close surveillance with the added potential for reducing unnecessary preterm deliveries among remaining women. © 2015 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Alpert Medical School at Brown University, Providence, RI, USA; Savjani Institute for Health Research, Windham, ME, USA
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Palomaki GE, Ashwood ER, Weck KE. A flawed challenge but valid recommendation: a response to Takoudes and Hamar. Ultrasound Obstet Gynecol 2015; 45:117. [PMID: 25557844 DOI: 10.1002/uog.14739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- G E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Alpert Medical School at Brown University, Providence, RI, USA
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Palomaki GE, Haddow JE, Haddow H, Salahuddin S, Geahchan C, Cerdeira AS, Verlohren S, Perschel FH, Horowitz G, Thadhani R, Karumanchi SA, Rana S. [24-OR]. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2014.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lyon E, Cockerill FR, Bale SJ, Beadling C, Bry L, Hagenkord J, Kulkarni S, Press R, Palomaki GE. Next Generation Sequencing in Clinical Diagnostics: Experiences of Early Adopters. Clin Chem 2015; 61:41-9. [DOI: 10.1373/clinchem.2014.222687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Elaine Lyon
- Associate Professor of Pathology, University of Utah School of Medicine, Salt Lake City, UT
- Medical Director, Molecular Genetics, ARUP Laboratories, Salt Lake City, UT
| | - Franklin R Cockerill
- Professor and Chair, Department of Laboratory Medicine and Pathology and
- President and CEO, Mayo Medical Laboratories, Mayo Clinic, Rochester, MN
- Current affiliation: Quest Diagnostics (10/1/14)
| | | | - Carol Beadling
- Assistant Director, Pathology Translational Research Laboratory, Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, Oregon
| | - Lynn Bry
- Director, Center for Clinical and Translational Metagenomics, Brigham & Women's Hospital and Associate Professor of Pathology, Harvard Medical School, Boston, MA
| | | | - Shashikant Kulkarni
- Associate Professor, Pathology and Immunology, Pediatrics and Genetics, Director of Cytogenomics and Molecular Pathology, Washington University School of Medicine, St. Louis, MO
| | - Richard Press
- Department of Pathology & Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine. Women & Infants Hospital, Alpert Medical School at Brown University, Providence, RI
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Lambert-Messerlian G, Eklund EE, Chien EK, Rosene-Montella K, Neveux LM, Haddow HR, Palomaki GE. Use of first or second trimester serum markers, or both, to predict preeclampsia. Pregnancy Hypertens 2014; 4:271-8. [DOI: 10.1016/j.preghy.2014.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/11/2014] [Indexed: 10/25/2022]
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O'Brien BM, Kloza EM, Halliday JV, Lambert-Messerlian GM, Palomaki GE. Maternal plasma DNA testing: experience of women counseled at a prenatal diagnosis center. Genet Test Mol Biomarkers 2014; 18:665-9. [PMID: 25137409 DOI: 10.1089/gtmb.2014.0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate the early introduction of circulating cell-free (ccf) DNA testing in a prenatal diagnosis center serving a statewide population. RESULTS A retrospective chart review of patients at high aneuploidy risk counseled during the two 10-week periods that documents indication, risk, maternal age, insurance coverage, decisions, and reasoning behind that decision. Among the 299 included women, indication was advanced maternal age (17% with and 56% without an additional indication), positive serum screen (15%), and abnormal ultrasound (12%). Uptake increased from 10% to 17%, as did patient awareness of the test (4% to 14%). Women with lower copayments were more likely to complete testing (23% vs. 5%, p<0.001). Most women completing testing (75%) wanted to avoid an invasive procedure, while those declining cited testing would not change anything (47%), preferred diagnostic testing (16%), negative follow-up testing (20%), and cost/insurance issues (9%). One of 42 tests was positive (trisomy 21). CONCLUSIONS Individual patient follow-up allows us to document ccfDNA-related patient decision-making. Nearly half of the women did not want further testing and one in seven preferred immediate diagnostic testing. Patient costs were a barrier to testing that, if avoided, could increase test uptake by 50% or more.
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Affiliation(s)
- Barbara M O'Brien
- 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women & Infants Hospital, The Alpert Medical School of Brown University , Providence, Rhode Island
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Haddow JE, Craig WY, Neveux LM, Haddow HRM, Palomaki GE, Lambert-Messerlian G, Malone FD, D'Alton ME. Implications of High Free Thyroxine (FT4) concentrations in euthyroid pregnancies: the FaSTER trial. J Clin Endocrinol Metab 2014; 99:2038-44. [PMID: 24606107 PMCID: PMC4037729 DOI: 10.1210/jc.2014-1053] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Lower birth weight has been reported in conjunction with high maternal free T4 (FT4) in euthyroid pregnancies, raising concerns for suboptimal outcomes. OBJECTIVE The objective of the study was to explore the relationships between high maternal FT4 and pregnancy complications in euthyroid women and to further examine the relationships among maternal size, FT4, and birth weight. DESIGN This was an observational multicenter cohort study. SETTING The study was conducted at prenatal clinics. STUDY SUBJECTS A total of 9209 euthyroid women with singleton pregnancies participated in the study. INTERVENTIONS There were no interventions. MAIN OUTCOME MEASURES Relationships between second-trimester high maternal FT4 and pregnancy/delivery complications and, among FT4, maternal weight and birth weight were measured. RESULTS Women in the highest FT4 quintile are younger and weigh less than women in quintiles 1-4; gestational diabetes and preeclampsia occur less often (P = < .001, P < .001, P < .001, and P = .05, respectively). Lowest median birth weight occurs among women in the highest FT4 quintile (P = < .001), but deliveries less than 37 weeks' gestation are not increased. Labor/delivery complications do not differ by FT4 quintile. Restricting analyses to maternal weight-adjusted small-for-gestational-age deliveries yields similar results, except for preeclampsia. In the highest maternal weight decile, adjusted median birth weight is 266 g higher (8.3%) than in the lowest weight decile; adjusted median FT4 is 0.91 pmol/L lower (6.8%). Among women in the highest FT4 decile, adjusted median birth weight is 46 g lower (1.3%) than in the lowest FT4 decile. All three relationships are statistically significant (P < .001, P < .001, and P = .004, respectively). CONCLUSIONS Lower median birth weight among euthyroid women with high FT4 is not associated with adverse pregnancy outcomes. Further investigation is indicated to determine how the variations in thyroid hormone concentration influence birth weight.
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Affiliation(s)
- James E Haddow
- Women and Infants Hospital and Alpert Medical School of Brown University (J.E.H., L.M.N., G.E.P., G.L.-M.), Providence, Rhode Island 02903; Savjani Institute for Health Research (J.E.H., L.M.N., H.R.M.H., G.E.P.), Windham, Maine 04062; Foundation for Blood Research (W.Y.C.), Scarborough, Maine 04070; Columbia University College of Physicians and Surgeons (F.D.M., M.E.D.), New York, New York 10032; and Royal College of Surgeons in Ireland (F.D.M.), Dublin 2, Ireland
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Pinar H, Palomaki GE, Haddow HRM, Rowles A, Torabi R. Comparison of radiographic femur measurements in stillbirths and neonatal deaths to ultrasound measurements in ongoing pregnancies. Pediatr Dev Pathol 2014; 17:107-11. [PMID: 24575801 DOI: 10.2350/14-01-1435-oa.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Identifying growth abnormalities in stillbirths is clinically useful but complicated by maceration. This is an observational study of consecutive postmortem examinations in which femur lengths and gestational age at delivery were collected, along with associated congenital anomalies and extent of fetal maceration. Between 2005 and 2012, 1530 consecutive postmortem examinations were performed and the information recorded. Fragmented fetuses (417), live-born fetuses that survived for more than 24 hours (134), fetuses with any signs of maceration (419), fetuses with known anomalies (98), and records with missing data (249) were excluded. The analyses focused on the remaining 265 nonmacerated stillborn fetuses and infants that survived for less than 24 hours after birth. The relationship between gestational age at delivery and femur length was computed, and a quadratic equation fit the data well between 12 and 40 weeks' gestation (R = 0.944). Gestational age-specific reference ranges for radiographic femur measurements in stillbirths are equivalent to those for ultrasound-determined measurements in ongoing pregnancies. These reference data may be useful in identifying growth abnormalities in nonmacerated stillborn fetuses.
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Affiliation(s)
- Halit Pinar
- 1 Department of Pathology and Laboratory Medicine, Division of Perinatal Pathology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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